What is Liver Cirrhosis
Liver Cirrhosis is a form of Chronic Liver Disease in which there is continuous damage of the liver over time, long enough to have the normal liver cells replaced by scar tissue [ abnormal tissues, much like the scab that forms over a superficial skin wound, but much tougher and stronger].
This changes the architecture of the liver, and by virtue of the liver having its normal cells being replaced by chaff [scar tissue] the liver gradually loses its function, and over time fails.
Chronic liver diseases are liver diseases in which the insult on the liver lasts longer than 6months. It is a spectrum which encompasses Chronic Hepatitis, Cirrhosis and Hepatocellular Carcinoma [liver cancer], in that order.
A case study
He had been vomiting frank blood and passing bloody stool all night, and he was getting weaker and dizzier with each episode. He struggled to his feet and with his last breath staggered towards the telephone, a drunken giant on the limbs of a mosquito.
If he was going to die in this God-forsaking hotel room, he was sure going to let the world know who killed him; the unscrupulous man was not going to go scot free. He got to the phone and began to punch furiously at the keypad ….11 digits was what separated him from letting the world know his story, and the pen that has sworn to put the final full stop to it.
As he was about to enter the last digit it came again, an irresistible urge to defecate; it was as if a sea wave of tsunamic proportions was threatening to push through his anus and his anal sphincters were doing a poor job keeping them back.
Just then he knew the battle was lost, he was not sure he was going to survive this episode of bloody stool; it would most likely leave him unconscious! Or worst still send him back unannounced to his maker for judgement. He tried to use the last minutes of his life to recall the terrible turn it had taken, this past two weeks.
He had gone to the Village for settlement of a Land Dispute. Midway through the proceeding’s things had gotten out of hand and a verbal duel had ensued. In the course of it, his rival had told him.
” A tubago m gi ime amughi amu, ihe o foziri bu ka m meminaa gi” [ I have given you a pregnancy you cannot deliver, what remains now is for me to eliminate you ] And that was his “confession”; right there he had admitted as earlier suspected that he was the one who diabolically engineered his grossly distended tummy, the “ime amughi amu”; and now he was making good of the second threat.
Yes, his tummy had been growing bigger by the day for the past 2 weeks. And he had been losing weight, loosing appetite, sweating a lot at night, and having intermittent yellowish discoloration of his eyes.
Both pastors and native doctors have all come to the consensus that his “rival” was behind the mysterious illness. While one group requested for fasting and praying, the other requested for some “omenani” to neutralise the effects of the diabolic powers at work.
Lying down now in the pool of his own blood, with the light of the day fading fast, and the very life of him threatening to go with the next torrent of bloody stool, he wondered where his eternity would be: heaven or hell? He had led a fast life: so many girls and too much booze, too much that they nicknamed him “Liquor”.
It sure is a highway to hell. If only he had known ….
The above scenario depicts the natural history of Liver Cirrhosis.
Causes/Risks factors of Liver Cirrhosis
The causes of Chronic Liver Disease and indeed Cirrhosis are numerous, and the risk factors are thus a constellation of the risks of the individual causes.
- Excessive alcohol consumption
- Unprotected Sex
- Multiple Sexual Partners
- Transfusion with an unscreened or poorly screened blood
- Aflatoxins [from groundnuts]
- Sharing of sharp objects and needles
- Getting Tattoos
- Hepatitis B Virus infection
- Hepatitis C Virus Infection
- Iron overload
Features of Liver Cirrhosis
Clinical features of Liver Cirrhosis includes:
- Weight loss
- Loss of appetite
- Low-grade fever
- Jaundice [yellowness of the eyes]
- Abdominal swelling
- Leg swelling
- Nausea, sometimes vomiting
- Easy bruising
- Gynecomastia [development of breasts in males]
- Loss of libido
- Testicular atrophy (Shrinking of the testes)
- Menstrual irregularities
Complications of Liver Cirrhosis
The complications of Liver Cirrhosis is a reflection of the loss of functional and structural integrity of the liver. And can be summarized as follows:
- Portal Hypertension: Due to the replacement of liver cells with fibrous tissue, the consistency of the liver is such that it can no longer allow blood flow through it easily. The resultant back pressure leads to Portal Hypertension with the consequences of;
- Splenomegaly (Spleen enlargement)
- Ascites [accumulation of fluid in the abdomen]
- Engorgement of blood vessels in the “stomach” which when ruptured by the excessive pressure leads to massive bleeding with vomiting and stooling of frank blood[ as in the scenario above]
- Loss of Synthetic Function of the Liver. This could lead to:
- Coagulopathy [ abnormally increased bleeding tendency due to lack of proteins that enhance blood clotting]
- Hypoalbuminaemia [ low blood protein leading to body swelling]
- Loss of Storage function. This may lead to Hypoglycemia [dangerously low blood sugar]
- Kidney Failure
- Lung dysfunction
- Hepatic Encephalopathy
- Altered level of consciousness due to effect of unprocessed [by the liver] toxins on the brain. Eventually progresses to coma.
- Progression to Cancer
Prevention of Liver Cirrhosis
Cirrhosis of the Liver and indeed any form of Chronic Liver disease has no cure. Except perhaps liver transplant which is not obtainable here in Nigeria. So prevention is very important. Preventive measures are targeted against the risks/causes, notably;
- Cessation of excessive alcohol indulgence.
- Safe sex practices
- Ensuring proper screening of blood and blood products before use
- Immunization against Hepatitis Virus.
Liver Cirrhosis is a terrible chronic condition without a cure. Preventive measures, however, exist to keep it at bay. Go low on alcohol, practice safe sex, get yourself immunized, eat healthily and keep your liver safe.
Dr Chibuike Joseph Chukwudum is a doctor who Studied Medicine and Surgery at Nnamdi Azikiwe University Awka. He is the former Medical Officer at Oakland specialist hospital,obosi.He also previously worked at Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State.